Worthington M G, de Groot M, Gunning A J, von Oppell U O
Department of Cardiothoracic Surgery, University of Cape Town, South Africa.
Ann Thorac Surg. 1995 Aug;60(2):272-4. doi: 10.1016/0003-4975(95)00415-h.
Isolated thoracic duct injuries as a result of penetrating chest trauma without any major vascular or tracheoesophageal injury seldom are seen.
A retrospective 13-year review identified 8 patients with this injury.
Seven had supraclavicular or suprascapular knife stabs, and the eighth had a low-velocity gunshot injury entering the mid-lateral right chest wall. All 7 stab victims presented with left-sided chylothoraces, and the site of injury of the thoracic duct was within Poirier's triangle, the borders of which are the arch of aorta, the left subclavian artery, and the vertebral column as seen from a lateral approach. Five patients initially were treated conservatively for 13.4 +/- 4.4 days without success. Surgical intervention thus was necessary and was successful in all 8 patients. The thoracic duct injury was controlled successfully through a left posterolateral thoracotomy in 6 patients. A supraclavicular repair was attempted in 1 patient but failed to control the leak and required reexploration via the supraclavicular approach. The right chylothorax from the gunshot injury was explored via a right posterolateral thoracotomy; the leak into the pleura was identified and obliterated.
As conservative management was uniformly unsuccessful, we advocate early operative management through a thoracotomy on the side of the chylothorax for this relatively rare injury.
穿透性胸部创伤导致孤立性胸导管损伤，且无任何主要血管或气管食管损伤的情况很少见。
一项为期13年的回顾性研究确定了8例此类损伤患者。
7例为锁骨上或肩胛上刀刺伤，第8例为低速枪伤，子弹进入右胸壁中外侧。所有7例刀刺伤患者均出现左侧乳糜胸，从侧方观察，胸导管损伤部位在普瓦捷三角区内，其边界为主动脉弓、左锁骨下动脉和脊柱。5例患者最初接受了13.4±4.4天的保守治疗，但未成功。因此有必要进行手术干预，8例患者均获成功。6例患者通过左后外侧开胸术成功控制了胸导管损伤。1例患者尝试进行锁骨上修复，但未能控制漏液，需要通过锁骨上入路再次探查。对枪伤导致的右侧乳糜胸通过右后外侧开胸术进行探查；发现并封闭了胸膜渗漏处。
由于保守治疗均未成功，对于这种相对罕见的损伤，我们主张早期通过患侧开胸术进行手术治疗。
